P2.077: Promoting children’s active play in nature via primary care-based intervention: a prospective mixed-methods multi-site study in Washington state

Background: Project Nature (PN), a multi-component intervention to promote children’s active play in nature (APN) during well-child checks (WCCs), includes: a conversation with a medical provider, a nature-based toy, and written and web-based family resources. Study aims were to assess feasibility, acceptability, and utility of PN from the perspective of parents and clinic staff.

Methods: We supported six primary care clinics in Washington state to implement PN during WCCs for 1-10 year olds. We conducted quantitative surveys of different cohorts of parents before and after the intervention (n=154 pre-intervention, n=131 post-intervention). Primary parent-level outcomes were the implementation and family perceptions of the four PN components. We analyzed pre-post differences using chi-square and Mann-Whitney U tests. Post intervention, we conducted qualitative interviews with 11 clinic staff members about implementation, coded and conducted thematic analysis.

Results: The proportion of parents reporting that their child’s medical provider encouraged their child to spend time outdoors every day increased from 54% pre-intervention to 85% post-intervention (p=0.02), and a higher proportion of parents post-intervention (86%) reported that their provider encouraged their child to engage in daily physical activity compared to pre-intervention (71%) (p=0.09). There was no significant change in all other anticipatory guidance topics post-intervention. Families reported strong satisfaction with all the intervention components and most families reported using the toy (89%), though utilization of the website and the brochure were low (10% and 35%, respectively). Clinic staff felt PN facilitated deeper conversation around APN, and believed that PN was feasibly implemented within their existing workflows.

Conclusion: PN is a feasible and acceptable approach for anticipatory guidance about, and family support of, APN. These results provide a foundation for a larger evaluation that assesses the impact of PN on families’ physical activity and nature behavior.